BACKGROUND: Previous studies have reported that fasting insulin and blood glucose levels are higher in postmenopausal than in premenopausal women and that insulin resistance was more serious in postmenopausal women. The effects of menopause on glucose metabolism have been well studied, but it is unclear whether age at menopause onset is associated with fasting blood sugar and HbA1c levels. The purpose of this study is to determine the effect of menopause age on diabetes and prediabetes.METHODS: We retrospectively analyzed data from the Sixth Korea National Health and Nutrition Examination Survey (2013–2015). The participants were 2,156 naturally menopausal women, except diabetes, stroke, coronary artery disease and cancer patients. The study population was divided into four groups according to the age of natural menopause onset ( < 40, 40–44, 45–55, and ≥56 years). Diagnosis of diabetes and prediabetes was based on the American Diabetes Association guideline. The association between menopause age and diabetes or prediabetes was analyzed by multiple logistic regression.RESULTS: Women reaching menopause at 40–44 years were 4.901 times more likely to have diabetes (odds ratio [OR], 4.901; 95% confidence interval [95% CI], 1.353–17.756, P=0.016) than those who reached menopause at an age of ≥56 years. Women with menopause at age < 40 years were 2.839 times more likely to have diabetes or prediabetes (OR, 2.839; 95% CI, 1.012–7.968, P=0.047).CONCLUSION: Women with premature menopause (< 40 years) have high risk of developing diabetes or prediabetes, and women with a menopause age of 40–44 years have high risk of developing diabetes.
Blood Glucose ; Coronary Artery Disease ; Diabetes Mellitus ; Diagnosis ; Fasting ; Female ; Glucose ; Humans ; Insulin ; Insulin Resistance ; Korea ; Logistic Models ; Menopause ; Menopause, Premature ; Metabolism ; Nutrition Surveys ; Prediabetic State ; Retrospective Studies ; Stroke

OBJECTIVE: Identification of new risk factors is needed to improve prediction of adverse outcomes in patients with three-vessel disease (TVD). The present study aimed to evaluate the prognostic values of serum chloride and sodium levels in patients with TVD. METHODS: We used data from a prospective cohort of consecutive patients with angiographically confirmed TVD. The primary endpoint was all-cause death. Cox proportional hazard regression was used to analyze the relationship of serum chloride and sodium levels with long-term outcomes of TVD patients. RESULTS: A total of 8,318 participants with available serum chloride and sodium data were included in this analysis. At baseline, patients in the low tertiles group of serum chloride level (⪕ 102.0 mmol/L) or serum sodium level (⪕ 139.0 mmol/L) had more severe disease conditions. During a median follow-up of 7.5-year, both low serum chloride level and low serum sodium level were found to be associated with an increased risk for mortality in univariate analysis. However, when both parameters were incorporated into a multivariate model, only low serum sodium level remained to be an independent predictor of all-cause death (hazard ratio: 1.16, 95% confidence interval: 1.01-1.34, P = 0.041). Modest but significant improvement of discrimination was observed after incorporating serum sodium level into the Synergy between percutaneous coronary intervention (PCI) with Taxus and Cardiac Surgery score. CONCLUSION Serum sodium level is more strongly associated with long-term outcomes of TVD patients compared with serum chloride level. Low serum sodium level is an independent risk factor for mortality, but only provides modest prognostic information beyond an established risk model.
Aged ; China ; epidemiology ; Chlorides ; blood ; Coronary Artery Disease ; blood ; diagnosis ; mortality ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Prospective Studies ; Sodium ; blood

OBJECTIVELow-density lipoprotein cholesterol (LDL-C) has been well known as the risk factor of coronary artery disease (CAD). However, the role of lipoprotein (a) [Lp(a)] in the development of CAD is of great interest but still controversial. Thus, we aim to explore the effect of Lp(a) on predicting the presence and severity of CAD in Chinese untreated patients, especially in combination with LDL-C.

METHODSWe consecutively recruited 1,980 non-treated patients undergoing coronary angiography, among which 1,162 patients were diagnosed with CAD. Gensini score (GS) was used to assess the severity of CAD. Lp(a) was measured by immunoturbidimetric method.

RESULTSPatients with CAD had higher level of LDL-C and Lp(a) compared with non-CAD (P < 0.05). Multivariable logistic regression revealed that Lp(a) > 205 mg/L (highest tertile) predicted 1.437-fold risk for CAD (95% CI: 1.108-1.865, P = 0.006) and 1.480-fold risk for high GS (95% CI: 1.090-2.009, P = 0.012) respectively. Interestingly, concomitant elevated level of Lp(a) and LDL-C conferred the highest risk for both presence [OR = 1.845, 95% CI: 1.339-2.541, P < 0.001] and severity [OR = 1.736, 95% CI: 1.188-2.538, P = 0.004] of CAD.

CONCLUSIONLipoprotein (a) is a useful marker for predicting the presence and severity of CAD, especially combined with LDL-C.

Aged ; Asian Continental Ancestry Group ; Biomarkers ; Coronary Angiography ; Coronary Artery Disease ; diagnosis ; Cross-Sectional Studies ; Female ; Humans ; Lipoprotein(a) ; blood ; Male ; Middle Aged ; Risk Factors

OBJECTIVETo study the association of red blood cell distribution width (RDW) and lipoprotein-associated phospholipase A2 (LP-PLA2) with the degree of coronary artery stenosis in patients with coronary artery disease (CAD) and the value of RDW combined with LP-PLA2 detection in accurate evaluation of coronary artery stenosis.

METHODSA total of 224 patients including 119 non-CAD cases and 105 CAD cases admitted in our hospital between June, 2013 and June, 2014 were enrolled in this study. The patients' baseline clinical data were collected and venous blood samples were obtained for detecting WBC, RDW-CV and LP-PLA2. The Gensini score of the CAD patients was calculated based on coronary angiographic findings.

RESULTSCompared with the non-CAD patients, CAD patients had significantly higher RDW-CV (P=0.009) and LP-PLA2 (P=0.004) levels. The CAD patients with high Gensini scores had also significantly higher RDW-CV (P=0.001) and LP-PLA2 (P<0.001) levels than those with low scores; RDW-CV and LP-PLA2 were significantly correlated with the Gensini score, and the area under curve of their combined detection was 0.931.

CONCLUSIONCombination of RDW and LP-PLA2 can improve the diagnostic accuracy of the degree of coronary artery stenosis in patients with CAD.

1-Alkyl-2-acetylglycerophosphocholine Esterase ; blood ; Coronary Angiography ; Coronary Artery Disease ; diagnosis ; Coronary Stenosis ; diagnosis ; Erythrocyte Count ; Erythrocytes ; cytology ; Humans

Angina Pectoris ; diagnosis ; Blood Pressure ; Coronary Angiography ; Coronary Artery Disease ; diagnosis ; Electrocardiography ; Exercise Test ; Female ; Heart Rate ; Humans ; Male ; Middle Aged ; Singapore

OBJECTIVEVery early-onset coronary artery disease (CAD) is a great challenge in cardiovascular medicine throughout the world, especially regarding its early diagnosis. This study explored whether circulating microRNAs (miRNAs) could be used as potential biomarkers for patients with very early-onset CAD.

METHODSWe performed an initial screening of miRNA expression using RNA isolated from 20 patients with angiographically documented very early-onset CAD and 20 age- and sex-matched normal controls. For further confirmation, we prospectively examined the miRNAs selected from 40 patients with very early-onset CAD and 40 angiography-normal controls.

RESULTSA total of 22 overexpressed miRNAs and 22 underexpressed miRNAs were detected in the initial screening. RT-qPCR analysis of the miRNAs obtained from the initial screening revealed that four miRNAs including miR-196-5p, miR-3163-3p, miR-145-3p, and miR-190a-5p exhibited significantly decreased expression in patients compared with that in controls (P<0.05). The areas under the receiver operating characteristic curve for these miRNAs were 0.824 (95% CI, 0.731-0.917; P<0.001), 0.758 (95% CI, 0.651-0.864; P<0.001), 0.753 (95% CI, 0.643-0.863; P<0.001), and 0.782 (95% CI, 0.680-0.884; P<0.001), respectively, in the validation set.

CONCLUSIONTo our knowledge, this is an advanced study to report about four serum miRNAs (miR-196-5p, miR-3163-3p, miR-145-3p, and miR-190a-5p) that could be used as novel biomarkers for the diagnosis of very early-onset CAD.

Aged ; Biomarkers ; blood ; Case-Control Studies ; Coronary Artery Disease ; blood ; diagnosis ; genetics ; Early Diagnosis ; Female ; Humans ; Male ; MicroRNAs ; blood ; genetics ; Middle Aged

Cardiovascular disease is one of the most frequent causes of death in both males and females throughout the world. However, women exhibit a greater symptom burden, more functional disability, and a higher prevalence of nonobstructive coronary artery disease (CAD) compared to men when evaluated for signs and symptoms of myocardial ischemia. This paradoxical sex difference appears to be linked to a sex-specific pathophysiology of myocardial ischemia including coronary microvascular dysfunction, a component of the 'Yentl Syndrome'. Accordingly, the term ischemic heart disease (IHD) is more appropriate for a discussion specific to women rather than CAD or coronary heart disease. Following the National Heart, Lung, and Blood Institute Heart Truth/American Heart Association, Women's Ischemia Syndrome Evaluation and guideline campaigns, the cardiovascular mortality in women has been decreased, although significant gender gaps in clinical outcomes still exist. Women less likely undergo testing, yet guidelines indicate that symptomatic women at intermediate to high IHD risk should have further test (e.g. exercise treadmill test or stress imaging) for myocardial ischemia and prognosis. Further, women have suboptimal use of evidence-based guideline therapies compared with men with and without obstructive CAD. Anti-anginal and anti-atherosclerotic strategies are effective for symptom and ischemia management in women with evidence of ischemia and nonobstructive CAD, although more female-specific study is needed. IHD guidelines are not "cardiac catheterization" based but related to evidence of "myocardial ischemia and angina". A simplified approach to IHD management with ABCs (aspirin, angiotensin-converting enzyme inhibitors/angiotensin-renin blockers, beta blockers, cholesterol management and statin) should be used and can help to increases adherence to guidelines.
Cardiovascular Diseases ; Cause of Death ; Cholesterol ; Coronary Artery Disease ; Coronary Disease ; Diagnosis* ; Exercise Test ; Female ; Heart ; Humans ; Ischemia ; Male ; Microvascular Angina ; Mortality ; Myocardial Ischemia* ; National Heart, Lung, and Blood Institute (U.S.) ; Prevalence ; Prognosis ; Sex Characteristics

Cardiovascular disease is one of the most frequent causes of death in both males and females throughout the world. However, women exhibit a greater symptom burden, more functional disability, and a higher prevalence of nonobstructive coronary artery disease (CAD) compared to men when evaluated for signs and symptoms of myocardial ischemia. This paradoxical sex difference appears to be linked to a sex-specific pathophysiology of myocardial ischemia including coronary microvascular dysfunction, a component of the 'Yentl Syndrome'. Accordingly, the term ischemic heart disease (IHD) is more appropriate for a discussion specific to women rather than CAD or coronary heart disease. Following the National Heart, Lung, and Blood Institute Heart Truth/American Heart Association, Women's Ischemia Syndrome Evaluation and guideline campaigns, the cardiovascular mortality in women has been decreased, although significant gender gaps in clinical outcomes still exist. Women less likely undergo testing, yet guidelines indicate that symptomatic women at intermediate to high IHD risk should have further test (e.g. exercise treadmill test or stress imaging) for myocardial ischemia and prognosis. Further, women have suboptimal use of evidence-based guideline therapies compared with men with and without obstructive CAD. Anti-anginal and anti-atherosclerotic strategies are effective for symptom and ischemia management in women with evidence of ischemia and nonobstructive CAD, although more female-specific study is needed. IHD guidelines are not "cardiac catheterization" based but related to evidence of "myocardial ischemia and angina". A simplified approach to IHD management with ABCs (aspirin, angiotensin-converting enzyme inhibitors/angiotensin-renin blockers, beta blockers, cholesterol management and statin) should be used and can help to increases adherence to guidelines.
Cardiovascular Diseases ; Cause of Death ; Cholesterol ; Coronary Artery Disease ; Coronary Disease ; Diagnosis* ; Exercise Test ; Female ; Heart ; Humans ; Ischemia ; Male ; Microvascular Angina ; Mortality ; Myocardial Ischemia* ; National Heart, Lung, and Blood Institute (U.S.) ; Prevalence ; Prognosis ; Sex Characteristics

BACKGROUNDWe investigated whether and to what extent the ratio between circulating fibrinogen (Fg) and its degradation products (FDP) reflects the severity of coronary artery disease (CAD) in type 2 diabetic patients.

METHODSPlasma levels of Fg and FDP were determined, and Fg/FDP ratio was calculated in 344 consecutive patients with type 2 diabetes and chest pain on exertion undergoing coronary angiography. The severity of CAD was evaluated by the number of significant CAD (>50% luminal diameter narrowing) and Gensini score.

RESULTSPlasma Fg was higher, but Fg/FDP ratio was lower in patients with significant CAD (n = 255) compared with those without (n = 89), due to a disproportionate increase in FDP. Fg and FDP correlated positively, while Fg/FDP ratio negatively, with the number of diseased coronary arteries and the tertile of Gensini score (all P values for trend < 0.01). After adjusting for age, sex, risk factors for CAD, lipid profiles, glycosylated hemoglobin A1c, creatinine, leukocyte count, and high-sensitivity C-reactive protein, Fg/FDP ratio remained an independent determinant for multivessel coronary disease (MVD) (odds ratio [OR], 0.869; 95% confidence interval [CI], 0.788-0.958, P = 0.005) and high tertile of Gensini score (OR, 0.797, 95% CI, 0.682-0.930, P = 0.004). The area under the curve of Fg/FDP ratio was larger than that of Fg for predicting the presence of MVD (0.647 vs. 0.563, P = 0.048) and Gensini score ≥ 30 (0.656 vs. 0.538, P = 0.026).

CONCLUSIONSElevated plasma Fg and FDP level and reduced Fg/FDP ratio are associated with presence of CAD, and Fg/FDP ratio is superior to Fg in reflecting severe coronary atherosclerosis for patients with type 2 diabetes.

Aged ; Coronary Angiography ; Coronary Artery Disease ; blood ; diagnosis ; metabolism ; Diabetes Mellitus, Type 2 ; blood ; metabolism ; Female ; Fibrin ; metabolism ; Fibrinogen ; metabolism ; Humans ; Male ; Middle Aged

PURPOSE: Acute coronary lesions commonly trigger out-of-hospital cardiac arrest (OHCA). However, the prevalence of coronary artery disease (CAD) in Asian patients with OHCA and whether electrocardiogram (ECG) and other findings might predict acute myocardial infarction (AMI) have not been fully elucidated. MATERIALS AND METHODS: Of 284 consecutive resuscitated OHCA patients seen between January 2006 and July 2013, we enrolled 135 patients who had undergone coronary evaluation. ECGs, echocardiography, and biomarkers were compared between patients with or without CAD. RESULTS: We included 135 consecutive patients aged 54 years (interquartile range 45-65) with sustained return of spontaneous circulation after OHCA between 2006 and 2012. Sixty six (45%) patients had CAD. The initial rhythm was shockable and non-shockable in 110 (81%) and 25 (19%) patients, respectively. ST-segment elevation predicted CAD with 42% sensitivity, 87% specificity, and 65% accuracy. ST elevation and/or regional wall motion abnormality (RWMA) showed 68% sensitivity, 52% specificity, and 70% accuracy in the prediction of CAD. Finally, a combination of ST elevation and/or RWMA and/or troponin T elevation predicted CAD with 94% sensitivity, 17% specificity, and 55% accuracy. CONCLUSION: In patients with OHCA without obvious non-cardiac causes, selection for coronary angiogram based on the combined criterion could detect 94% of CADs. However, compared with ECG only criteria, the combined criterion failed to improve diagnostic accuracy with a lower specificity.
Aged ; Biomarkers/*blood ; Case-Control Studies ; Coronary Angiography ; Coronary Artery Disease/blood/*diagnosis/epidemiology ; Echocardiography/*methods ; Electrocardiography/*methods ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/blood/*diagnosis/epidemiology ; Out-of-Hospital Cardiac Arrest/*diagnosis ; Sensitivity and Specificity ; Troponin T